Variability in caries management decision-making in a dental school setting.

Abstract

OBJECTIVE\nTo assess variability in caries management decision-making by faculty and dental students. Understanding sources of variability during training can aid in implementing evidence-based clinical decision-making in caries management.\n\n\nMETHODS\nA voluntary, anonymous survey including clinical scenarios was distributed online to dental students in their first (D1) and third-year (D3) of training, and to faculty in the Department of Cariology, Restorative Sciences and Endodontics.\n\n\nRESULTS\nThe response rate was\xa0100% (108/108) for D1 students, 56% (73/130) for D3 students, and 39% (34/88; 12 full-time and 22 part-time) for faculty. D1 students, who were completing a cariology course, were in general more conservative in restorative thresholds for less severe caries lesions than D3 students and sometimes clinical faculty (e.g., for lesions at the DEJ, a significantly [p\xa0<\xa00.05] higher percentage of D3 students would restore these [53%] compared to D1 students and faculty [19% and 18%, respectively; p\xa0>\xa00.05]). For all groups, the threshold for doing restorative intervention was shifted toward less severe caries lesions as the caries risk increased (e.g., very few respondents would restore an occlusal lesion confined to enamel, with significantly [p\xa0<\xa00.05] less percentage of D1 students [lower risk scenario-LR\xa0=\xa04%; higher risk scenario-HR\xa0=\xa022%] compared to D3 students and faculty [LR\xa0=\xa015% and 18%; HR\xa0=\xa066% and 62%, respectively; p\xa0>\xa00.05]). Class lectures/preclinical instructors were the most important factor influencing decision-making for D1 students, versus clinical experiences/instructors for D3 students.\n\n\nCONCLUSION\nAlthough the majority of respondents used best-evidence deciding caries management, there was variability in how to manage less severe lesions, with caries risk influencing clinical thresholds, and clinical experiences influencing students decision-making over time.